Individual
TARA A DE JESUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3860 W OGDEN AVE, CHICAGO, IL 60623-2460
(872) 588-3000
Mailing address
3229-43 W 47TH PL., CHICAGO, IL 60632-3011
(773) 254-6044
(773) 254-6115
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036108171
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036108171
STATE LICENSE
IL
01
—
336069630
CS LICENSE
IL
Enumeration date
05/31/2006
Last updated
03/07/2023
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